| NPI | 1912966755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301057353) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 118) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2026-02-16 |